Childhood Cancers: Long-Term Effects of Treatment
All medical treatments have both benefits and potential harms. This may be more true for cancer treatments than for other medical therapies. Some cancer treatments have late effects even after they have led to a cure. This is especially true for childhood brain cancer and leukemia. Now that childhood cancer survivors are living longer, researchers are beginning to learn more about the possible long-term (late) effects of childhood cancer treatments. Your child’s doctor will make every effort to select treatments that will minimize future risks, as well as discuss what you and your child can expect. This article will acquaint you with some topics that might come up in such a discussion. It is important to keep the possible late effects of cancer treatment in perspective.
Late Effects of Treatment
In most cases, cancer treatment involves surgery, and/or chemo-
therapy. For some cancers, treatment may also include a stem cell transplant
. Radiation therapy uses high-energy rays to kill or shrink cancer cells, while chemotherapy uses one or more drugs. A stem cell transplant replaces damaged stem cells in the bone marrow with new ones from a donor. The stem cells will produce healthy red and white blood cells, and platelets. Late effects from chemo- and radiation therapy include second cancers and fertility problems. If a stem cell transplant was needed in addition to other treatments, some late effects can be more severe.Children who have been successfully treated for childhood cancer face a small but increased risk of developing a second cancer—of an entirely different kind—during their lifetime. Scientists still don’t completely understand second cancers and they currently have no way of predicting which children are susceptible and which children are not. This risk may diminish in the future as doctors use new cancer treatments specifically designed to minimize the development of second cancers.While most childhood cancer survivors are able to have children, fertility problems can still occur due to cancer treatment. Chemo- and radiation therapy affect pregnancy rates more than other treatments. Treatment may lower sperm count in boys, while ova may be affected in girls. Males are more likely to have fertility problems.Your child's age during treatment may also have an effect. For example, boys who have not reached puberty are less likely to be affected by fertility issues than boys who have.If your child has gone through puberty and is facing cancer treatment, there are ways to preserve fertility in advance. For boys this may include sperm banking, the process of collecting and freezing sperm samples for the future, and organ shielding during radiation treatment. In girls, this may include egg freezing, hormone treatments, organ-saving surgical procedures, and organ shielding. Cancer treatments can also delay puberty in both boys and girls.Your child's doctor can advise you whether your child’s treatment has a significant chance of affecting fertility. However, if any genetic material from testicular or ovarian tissue is damaged, the risk of abnormalities with your children may be higher.In general, children born to survivors of childhood cancer are not affected by their parent’s history of cancer treatment.It is important to discuss options before your child starts treatment.